Blood pressure control in treated hypertensive patients: clinical experience

Too many treated hypertensive patients remain uncontrolled all over the world. Patients’ compliance but also the management of adequate treatment by the physician are essential to improve blood pressure control. The present study assesses the prevalence of control of SBP and DBP among patients referred to an hypertension clinic by general practitioners and specialists to measure treatment efficacy. Characteristics of uncontrolled patients’ treatment are analysed. Were recorded: Office Blood Pressure (OBP), 24hours ABPM, history of cardiovascular risk factors and detailed current antihypertensive treatment. out of 156 patients (78men/78women), 31% suffer from type II diabetes, 8% from renal insufficiency, 31% are obese and 26% have CV risk. Mean age is 56±13 years, mean duration of HT is 8±8 years and mean duration of treatment is 6±7 years. A total of 80% of patients have OBP higher than 140 and/or 90 mmHg. Average 24h ABPM values confirmed uncontrolled BP in 58% of patients with 26% having levels >135-85, 21% having isolated uncontrolled Systolic BP and 11% having isolated uncontrolled Diastolic BP. When comparing controlled and uncontrolled patients, age or rates of CV risks could not explain differences. However, half of controlled patients take only 1 drug whereas uncontrolled ones are treated for most by 2 to 4 drugs combinations. In controlled patients, 2/3 receive diuretics(D) or beta-blockers (B-Bl)as monotherapy while uncontrolled receive majorly Ca antagonists and sartan’s. In patients under 2 drugs combination, controlled ones receive significantly more a D-B.Bl association while uncontrolled receive more combinations with Ca antg., ACE or sartan’s.78% of diabetics are treated by 2 to 4 drugs but 55%of them remain uncontrolled. In patients treated by a triple association, surprisingly, no more than 79 % receive a diuretic. ABPM improves treatment efficacy measurement. According to that reference method, more than half of treated patients remain higher than advised JNC6 target BP despite high rates of patients treated by combinations of several drugs. In that way, questions about choice, power of actual drugs and necessity of systematic drugs combinations with higher doses must find answer in future trials with special attention to the apparent difficulty to reach target Systolic BP in so many patients.